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Anchor lead: Why do most cancers arise from random mutations? Elizabeth Tracey reports

Random mutations are the cause of most cancers, a new paper published in Science by Bert Vogelstein and Cristian Tomasetti at Johns Hopkins shows. Tomasetti says these mutations do have a purpose.

Tomasetti: From my point of view its an essential requirement for the system. Evolution works because there are mutations. :08

Vogelstein explores the idea further.

Vogelstein: The idea that most of the mutations that are responsible for cancer occur randomly is unsettling. Everyone would like to believe we’re in control. Even Einstein had difficulty with this concept, that some aspects of life are totally random. Cellular mistakes are the engines of evolution. Thought about in that way cancer, to a large extent, is really a side effect of evolution. :27

Both agree that the findings point to early detection as the likely most effective strategy to one day cure cancer.  At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: What percentage of common cancers are due to random mutations? Elizabeth Tracey reports

Randomly acquired mutations in DNA account for the majority of cancer, a striking new Johns Hopkins study published in Science by Bert Vogelstein and Cristian Tomasetti shows. Tomasetti reveals some of the numbers.

Tomasetti: In lung cancer, where it’s very well known the effect of smoking, and other environmental factors, we estimate that 65% of the mutations are due in fact to environmental and lifestyle factors. About 35% of the mutations are due to random mutations. If we look at cancer types like pancreatic cancer in that case we estimate that 77% is due in fact to random mutations. :30

Tomasetti says heredity plays a very small role in the total number of cancers, about 5%. He says that most people can now stop feeling guilty that somehow they’ve caused their disease since so many cancers arise by this random mutation mechanism. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: How much of developing cancer is under your control? Elizabeth Tracey reports

How much do your genes or what you choose to eat or drink have to do with whether you will develop cancer? Not nearly as much as you might think, a new Johns Hopkins study published in the journal Science and led by Bert Vogelstein and Cristian Tomasetti shows. Vogelstein explains that another factor is the major driver in most cancers.

Vogelstein: This factor is due to random mutations that normal cells acquire each time they divide. We believe that these random mutations account for the majority of the mutations that cause cancers. This is the first time that the proportion of cancer gene mutations due to these random mutations as well as environmental and hereditary factors has been able to be quantified. :30

So most cancers are the luck of the draw, the findings show. At Johns Hopkins, I’m Elizabeth Tracey.

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DNA molecule

This week’s topics include ‘drip and ship,’ direct to consumer ads, steroid injections for low back pain, and cancer mutations.

Program notes:
0:37 Drip and ship
1:37 Best to closest stroke center
2:37 TPA helpful in expanding window
3:43 Mutations relative to cancer
4:43 Some inherited genes
5:43 So many people feel guilty
6:42 Steroid injections for low back pain
7:42 Would a second injection help?
8:22 Direct to consumer ads and testosterone
9:22 Even without having a blood test
10:49 End
Related blog: https://podblog.blogs.hopkinsmedicine.org/2017/03/24/random-cancers/
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Anchor lead: When opioids are combined with another drug, the chances of overdose increase, Elizabeth Tracey reports

Opioid overdose is epidemic, and now a study in the British Medical Journal shows that when these drugs are taken with benzodiazapines such as Valium, the chance of overdose shoots up. Constantine Lyketsos, director of psychiatry at Johns Hopkins, comments.

Lyketsos: Opioids, even without concomitant use are not designed to be used chronically period end of story. It is very rare that its appropriate for someone to be on an opiate chronically. Combine them with these other medications that also act on the brain and yes, you have a greater likelihood of side effects and in some instances catastrophic side effects including death. :20

Lyketsos says the problem is especially acute for older folks.

Lyketsos: I challenge everybody, every older person and people who are in their family who are involved in caring for them, they should challenge their physician at every visit to clearly justify every medication they’re prescribing. And I think if you do that systematically you appreciate that many seniors need far fewer medicines than are being prescribed. :18

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Taking too many medicines that affect the brain has consequences, Elizabeth Tracey reports

At least three medicines that impact the brain- the number of older Americans who are on such a regimen has doubled over a decade, a recent study finds. Constantine Lyketsos, director of psychiatry at Johns Hopkins, sounds a note of warning.

Lyketsos: Some of these medicines are risk factors for dementia whether they directly cause brain damage that leads to dementia or whether they affect the brain in such a way that they unmask a brain process and therefore lead to dementia is not clear. Also we know that these medicines or some of them are prescribed to patients or individuals with dementia that they seem to accelerate progression. So their increased use raises concerns both for an increased occurrence of dementia, in relationship to these and also for a worse outcome.  :33

Lyketsos says all medicines should only be taken for an appropriate period of time, and reassessment is continuously needed, as the effects may be cumulative or interactive. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Many older Americans are taking three or more medicines that impact the brain, Elizabeth Tracey reports

Opioids, sleep medicines, medicines for psychiatric conditions.  The number of retired persons and older who are taking at least three such medicines has doubled over a decade, and these medicines directly affect the brain. Constantine Lyketsos, director of psychiatry at Johns Hopkins, identifies at least one contributing factor.

Lyketsos: I think to a great extent this reflects the reduction in access to specialty mental health services. And what’s happening is that individuals and our seniors especially are presenting to their primary care doctors with mental health complaints. Primary care doctors are busy, mental health complaints require more time, than say, a high blood pressure complaint, and so prescriptions are being written perhaps with less careful attention and are being maintained when perhaps they’re not needed anymore.   :31

Lyketsos says caution is needed here, as well as careful review of all medicines someone is taking. At Johns Hopkins, I’m Elizabeth Tracey.

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